SRC-CTC S.B. 1394 77(R)   BILL ANALYSIS


Senate Research Center   S.B. 1394
77R9281 TBy: Fraser
Health & Human Services
3/29/2001
As Filed


DIGEST AND PURPOSE 

Recently, the Rural Community Health System (RCHS) developed, in
coordination with private sector program partners, an approach to address
the economic development needs of rural communities by securing a viable
health care system.  Using collaboration between major insurers,
re-insurers, and rural communities to share in the decision making process,
the RCHS program offers a strategic solution that will enable the state to
achieve budget certainty for its Medicaid program while increasing rural
community access to insured program alternatives for underinsured and
uninsured citizens.  As proposed, S.B. 1394 makes the technical revisions
to Chapter 20C, Insurance Code, needed in order for RCHS to implement this
model. 

RULEMAKING AUTHORITY

Rulemaking authority is expressly granted to the commissioner of insurance
in SECTION 4 (Article 20C.04, Insurance Code) of this bill. 

SECTION BY SECTION ANALYSIS

SECTION 1.  GOALS OF SYSTEM.   Provides that the statewide rural health
care system (system) established under Chapter 20C, Insurance Code, is
designed to protect and enhance the rural health care delivery system by
performing certain actions, rather than to incorporate certain
consumeroriented attributes.  Provides that these actions include, among
other things, preservation of significant traditional provider-patient
relationship, rather than physician-patient relationship, and an emphasis
on disease management, rather than an emphasis on quality improvement
including obtaining accreditation. 

SECTION 2.  Amends Article 20C.02, Insurance Code, to redefine "enrollee"
and "health care services."  Deletes existing text related to certain
standards imposed by the commissioner of insurance (commissioner). 

SECTION 3.  Amends Article 20C.03, Insurance Code, to provide that the
system is established to sponsor, arrange for, or provide health care
services that comply with certain requirements.   

SECTION 4.  Article 20C.04, Insurance Code, to provide that the system is
authorized to sponsor, provide, or arrange for the provision of health care
services for enrollees as described in Article 20C.03.  Deletes existing
text related to an exception to a part of this article.  Requires the
system, if the system seeks to sponsor, arrange, or provide health care
services to enrollees under a private or commercial program, to meet each
requirement imposed by current insurance laws unless the commissioner
grants, by rule, an exception to such requirements on the basis of
distance, network adequacy, and scope of coverage.  Deletes existing text
related to the system obtaining a certificate of authority and certain
conditions arising from the system seeking a certificate. 

SECTION 5.  Amends Article 20C.06, Insurance Code, to require that six
directors be selected, rather than appointed by providers participating in
the system as representatives of the providers, in the manner provided by
Article 20C.10 of this code.  Requires six directors to be selected, rather
than appointed by the governor, from persons residing in the territorial
jurisdictions of the participating  providers.  Requires six directors to
be appointed from among licensed physicians who reside and practice in the
territorial jurisdictions of the participating providers, rather than be
appointed by the governor. 

SECTION 6.  Amends Article 20C.08, Insurance Code, to authorize the board
of directors of the system, on a majority vote, to contract for management
or support services, contract with, rather than hire, consultants,
attorneys and other professional, and retain, rather than hire, such other
staff as necessary to implement the duties of the system. 

SECTION 7.  Amends Article 20C.14, Insurance Code, to authorize the
commissioner of health and human services, notwithstanding any other law,
to include the system in any voluntary pilot or demonstration program which
seeks to evaluate the use of an insured model for beneficiaries of the
Texas Medical Assistance Program in a rural area that is not currently
included in an existing Medicaid managed care pilot program area and that
incorporates the principles of prevention, disease management and studies
the use of Promotora's as described in H.B. 1864, 76th Session. 

Effective date: 90 days after adjournment.